M. Brownell Anderson

BEME systematic review: Predictive values of measurements obtained in medical schools and future performance in medical practice

Background: Effectiveness of medical education programs is most meaningfully measured as performance of its graduates. Objectives: To assess the value of measurements obtained in medical schools in predicting future performance in medical practice. Methods: Search strategy: The English literature from 1955 to 2004 was searched using MEDLINE, Embase, Cochranes EPOC (Effective Practice and Organization of Care Group), Controlled Trial databases, ERIC, British Education Index, Psych Info, Timelit, Web of Science and hand searching of medical education journals. Inclusion & exclusions: Selected studies included students assessed or followed up to internship, residency and/or practice after postgraduate training. Assessment systems and instruments studied (Predictors) were the National Board Medical Examinations (NBME) I and II, preclinical and clerkship grade-point average, Observed Standardized Clinical Examination scores and Undergraduate Deans rankings and honors society. Outcome measures were residency supervisor ratings, NBME III, residency in-training examinations, American Specialty Board examination scores, and on-the-job practice performance. Data extraction: Data were extracted by using a modification of the BEME data extraction form study objectives, design, sample variables, statistical analysis and results. All included studies are summarized in a tabular form. Data analysis and synthesis: Quantitative meta-analysis and qualitative approaches were used for data analysis and synthesis including the methodological quality of the studies included. Results: Of 569 studies retrieved with our search strategy, 175 full text studies were reviewed. A total of 38 studies met our inclusion criteria and 19 had sufficient data to be included in a meta-analysis of correlation coefficients. The highest correlation between predictor and outcome was NBME Part II and NBME Part III, r = 0.72, 95% CI 0.30–0.49 and the lowest between NBME I and supervisor rating during residency, r = 0.22, 95% CI 0.13–0.30. The approach to studying the predictive value of assessment tools varied widely between studies and no consistent approach could be identified. Overall, undergraduate grades and rankings were moderately correlated with internship and residency performance. Performance on similar instruments was more closely correlated. Studies assessing practice performance beyond postgraduate training programs were few. Conclusions: There is a need for a more consistent and systematic approach to studies of the effectiveness of undergraduate assessment systems and tools and their predictive value. Although existing tools do appear to have low to moderate correlation with postgraduate training performance, little is known about their relationship to longer-term practice patterns and outcomes.

Growing use of standardized patients in teaching and evaluation in medical education

In May 1993, a survey was sent to each U.S. and Canadian medical school requesting information about how standardized patients (SPs) are used for teaching and evaluating clinical skills. The survey was done to determine what change, if any, there has been in the use of SPs since a similar survey was done in 1989 (by Paula Stillman, MD, & colleagues1). Ninety‐seven percent of the schools responded to the survey. One hundred eleven schools reported using SPs—an increase from 94 schools in 1989. Results of the survey support the perception that the use of SPs in the medical school curriculum is increasing, particularly the use of SPs for teaching and evaluating interviewing, medical history, and complete physical examination. Thirty‐nine of the 111 schools require students to take an examination before graduation, which involves using SPs to evaluate clinical skills. The need for a national resource or databank to house SP cases, training materials, and evaluation forms is highlighted.

Medical education in the United States and Canada, 2010.

The authors present an overview of the educational programs, infrastructure to support them, and the assessment strategies of 128 medical schools in the United States and Canada, based on reports submitted by those schools and published in this supplement to Academic Medicine. The authors explore many important changes that have occurred since the publication of the Flexner Report in 1910 as well as the progress that is evident since a similar collection of medical school reports was published in September 2000, also as a supplement to Academic Medicine. Drawing on the reports, the authors summarize, among other topics, the advances that have taken place in the support for faculty, the funding of medical student education, changes in pedagogy and assessment, and the expansion of medical education to distributed models and regional campuses.The authors observe that the reports from the 128 schools illustrate that medical student education has undergone and continues to undergo substantive change, has advanced markedly since the reforms stimulated by the Flexner Report, and has continued to evolve during the past decade. The reports illustrate the strength of support for the educational programs, even in a time of financial constraints, and the increasing recognition of the scholarly contributions of faculty through teaching. The authors provide examples of the changes in pedagogy and new topics in the required curriculum in the past decade and describe selected highlights of the 128 educational programs.

International Exchange Programs and U.S. Medical Schools

Background International health experiences have been shown to increase students’ and residents’ interest in public health, their likelihood of choosing a career in primary care, and their commitment to serving the underserved. The purpose of the current study is to describe the international experiences available to students and residents at U.S. allopathic medical schools. Method An online survey was conducted to collect information about the types of international opportunities in medical education provided to faculty, students, and residents at U.S. allopathic medical schools. Results Reponses from 103 representatives of 96 U.S. allopathic medical schools were included in the analysis. A variety of opportunities for students and residents was reported, with 59% of the respondents reporting elective rotations for residents, 11% reporting a global health track for students, and 45% reporting opportunities to perform preclinical research abroad. Conclusions Despite associated costs and risks, U.S. medical schools are developing and refining international health experiences for medical students and residents.

Caring attitudes in medical education: perceptions of deans and curriculum leaders.

BACKGROUNDSystems of undergraduate medical education and patient care can create barriers to fostering caring attitudes.OBJECTIVEThe aim of this study is to survey associate deans and curriculum leaders about teaching and assessment of caring attitudes in their medical schools.PARTICIPANTSThe participants of this study include 134 leaders of medical education in the USA and Canada.METHODSWe developed a survey with 26 quantitative questions and 1 open-ended question. In September to October 2005, the Association of American Medical Colleges distributed it electronically to curricular leaders. We used descriptive statistics to analyze quantitative data, and the constant comparison technique for qualitative analysis.RESULTSWe received 73 responses from 134 medical schools. Most respondents believed that their schools strongly emphasized caring attitudes. At the same time, 35% thought caring attitudes were emphasized less than scientific knowledge. Frequently used methods to teach caring attitudes included small-group discussion and didactics in the preclinical years, role modeling and mentoring in the clinical years, and skills training with feedback throughout all years. Barriers to fostering caring attitudes included time and productivity pressures and lack of faculty development. Respondents with supportive learning environments were more likely to screen applicants’ caring attitudes, encourage collaborative learning, give humanism awards to faculty, and provide faculty development that emphasized teaching of caring attitudes.CONCLUSIONSThe majority of educational leaders value caring attitudes, but overall, educational systems inconsistently foster them. Schools may facilitate caring learning environments by providing faculty development and support, by assessing students and applicants for caring attitudes, and by encouraging collaboration.

CurrMIT: a tool for managing medical school curricula.

The AAMC Curriculum Management & Information Tool (CurrMIT) is a relational database containing curriculum information from medical schools throughout the United States and Canada. CurrMIT can be used to document details of instruction, such as outcome objectives, resources, content, educational methods, assessment methods, and educational sites, which are being employed in curricula. CurrMIT contains basic information about nearly all required courses and clerkships being offered in the United States and Canada. The database contains descriptions of more than 15,000 courses and clerkships; approximately 115,000 “sessions”—e.g., lectures, labs, small-group discussions—and more than 400,000 keywords and word strings documenting the specific details of instruction associated with the courses, clerkships, and sessions. Some specific uses that schools have made of CurrMIT include review of demographics among patient cases being used in a case-based curriculum; comparisons of educational experiences between two geographically separate clinical campuses; and identification of unplanned redundancies and gaps in curricular content. CurrMIT has been designed to accommodate data from virtually any medical school curriculum; “traditional 2+2” curricula, problem-based curricula, and systems-based curricula, and variations of each of these, have been entered in CurrMIT by medical schools. The authors give an overview of the technology upon which the system is built and the training materials and workshops that the AAMC provides to faculty to support CurrMITs use, and end by describing enhancements being planned for the system.

The National Evaluation of Senior Mentor Programs: Older Adults in Medical Education

OBJECTIVES: To identify models for senior mentor programs (SMPs), critical factors in program development, achievement of goals and objectives, effect on medical school environment, and future of programs.

The Arabian Gulf University College of Medicine and Medical Sciences: a successful model of a multinational medical school.

In the late 1970s, leaders of the Arabian [corrected] Gulf countries proposed a novel idea of a joint educational and cultural venture: establishing a new regional university based in the Kingdom of Bahrain that would be managed as a multinational consortium of Gulf countries including Saudi Arabia, United Arab Emirates, Kuwait, Oman, Qatar, and Bahrain. It was intended to promote higher education and research in the Gulf region; to serve the development needs of the region; to reflect the unique economic, social, and cultural attributes of the Gulf communities and their environments; and to respond to the health care needs of the member countries. Since its inception in 1982, the College of Medicine and Medical Sciences (CMMS) at Arabian Gulf University (AGU) has adopted the educational philosophy of problem-based learning (PBL) and self-directed, student-centered education. The curriculum is integrated, with early introduction of education to foster clinical skills and professional competencies. The strategic alliance with the health care systems in Bahrain and other Gulf regions has created a successful model of efficient and effective initialization of health care resources in the community. The experience that has accumulated at the AGU-CMMS from introducing innovative medical education has allowed it to take a leadership position in medical education in the Gulf region. The original goals of this unique experiment have been realized along with unanticipated outcomes of spearheading changes in medical education in the Gulf region. Old and new medical schools have adopted several characteristics of the AGU educational program. Several elements contributed to its success: a clear vision of providing quality medical education and realizing and sustaining this vision by a supportive leadership at the university and college levels; an alliance with the regional health care systems; a dedicated faculty who have been able to work as a team while continually developing themselves; proper student selection and the creation of a culture of student/faculty partnerships in education and in building an international reputation and credibility by cooperating with reputable international universities and organizations.

Faculty Views of Reimbursement Changes and Clinical Training: A Survey of Award-Winning Clinical Teachers

Background: Prominent authorities believe that managed care and governmental policies are compromising the clinical education of future physicians. Purpose: This study sought the views of clinical teachers to quantify the extent to which managed care and governmental policies have changed clinical education. Methods: Questionnaires were mailed to faculty that U.S. medical schools had recognized for clinical teaching excellence. Measures included reports of change in quality of clinical teaching due to payment regulations, Liaison Committee on Medical Education (LCME) and Residency Review Committee (RRC) requirements, and institutional support for teaching; change in numbers of students-trainees in clinics; need to generate more clinical revenue; and change in enjoyment of teaching. Other measures about clinical teaching included faculty attitudes, institutional rewards, and teaching different levels of students. Characteristics of the respondents also were measured. Results: Faculty reported that payment regulations have affected clinical teaching negatively and that faculty need to generate more clinical revenue. Institutions tend to provide a supportive teaching environment but do not reward teaching financially. Intrinsic incentives for teaching increase as the level of student increases. Faculty reports did not differ by medical specialty or other faculty characteristics. Differences among medical schools occurred on all measures. Conclusions: Clinical education is being negatively affected, but not yet critically. Continued clinical financial pressures on faculty will affect all levels of clinical education, particularly for medical students. Differences among institutions indicate that individual schools can moderate or exacerbate the impact of external forces on the teaching faculty. Medical schools should monitor increasing pressures on faculty and ensure that goals, processes, support, and rewards for clinical teaching are proportionate to those for clinical care.

Conference proceedings and consensus statements of the millennium conference 2007: a collaborative approach to educational research.

Background: Research in medical education is stymied by a variety of methodological, logistical, and institutional challenges. Multicenter collaboration may advance the current state of medical education research by increasing subject sample size, harnessing the power of collective expertise, and garnering visibility for issues of national importance. Summary: We convened the “Millennium Conference 2007: A Collaborative Approach to Educational Research” in May 2007 to consider the role of national initiatives in addressing challenges in educational research. We selected 9 medical schools through a competitive application process to participate as school teams. We led participants through structured discussions about the challenges of educational research and the opportunities offered through national collaboratives. School teams also met to refine their current local educational research initiatives. Conclusions: A group of committed stakeholders met to consider a national educational research agenda. The recommendations from this conference proceed from consensus reached by the participants.